If case you haven’t heard, it’s Shelly’s Birthday. Shelly, or as her friends on the interwebs know her as, @shell1972 , is turning a young and vivacious 28 today and I would like to take this opportunity to say “Happy Birthday” to her.
Shelly is pretty much my most vocal twitter supporter and religiously Retweets my posts. I’m grateful for that. Plus, she drove all the way to FDIC to hang out with us and that was cool.
Happy Birthday Shelly!
I meant to write something about the Fiasco in South Fulton and the “No Pay, No Spray” issue.
I’ve, not surprisingly, got opinions, you see. I wanted to get some of them out there.
So I did it on the Firefighter Netcast last night. I missed John and Rhett and the cast of characters (Yea, REAL characters) on the show last night were a veritable Who’s Who of the Fire/EMS blogosphere.
It’s kind of a long show, but the show page has a lot of links to everyone’s posts on this issue. It’s important for us to get involved. All of us.
Go have a read and a listen.
This article came across my Twitter stream this morning. It regards a letter sent to the Centers for Medicare/Medicaid Services by the Governor of Colorado informing them that in some Colorado hospitals it is now acceptable for Certified Registered Nurse Anesthetists to work independently of physician supervision.
The article, which is in the form of a letter written to the editor of The Aspen Times, is written by a Dr. Paul Rein who is the President of the Virginia Anesthesia and Peroperative Care Specialists. He takes issue with the lack of physician oversight and is “quite concerned” about it.
I think that the letter is important for EMS people to read. Especially us EMS people that are looking at how to expand our profession, grow our scope of practice, and expand our skill sets. It shows that there are struggles over these kinds of boundary and oversight issues all over the healthcare arena and that the politics and power struggles aren’t just limited to those of us that ride ‘round in ambulances.
The full text of the letter can be found here at The Aspen Times: http://www.aspentimes.com/article/20101004/LETTER/101009942/1020&ParentProfile=1061
The parallels I can draw from this issue to EMS are striking and enlightening. Here are some of the parts of the letter that I found the most interesting:
“A nurse anesthetist is an advanced practice registered nurse who has received special training to administer anesthesia, usually being supervised by an anesthesiologist. Anesthesiologists are physicians who, after medical school, receive an additional four to five years of specialized training during residency. Not only do anesthesiologists function in the operating room but they are trained to medically evaluate patients prior to surgery and to take care of problems that may arise immediately after surgery. In a few small hospitals a nurse anesthetist may be supervised by the surgeon if there is no anesthesiologist.”
I was curious as to the educational standards of a Certified Registered Nurse Anesthetist and so I went to their National Association’s web site: Http://www.AANA.com – It says this:
“The requirements for becoming a Certified Registered Nurse Anesthetist (CRNA) mainly include having a bachelor’s degree in nursing, or other appropriate baccalaureate degree, Registered Nurse licensure, a minimum of 1 year acute care experience (ICU, ER for example), and the successful completion of both an accredited nurse anesthesia educational program and the certification examination.”
(Source: http://www.aana.com/BecomingCRNA.aspx?id=98&linkidentifier=id&itemid=98)
Huh.
Actually, I wasn’t familiar with the requirements for a CRNA before I read that, but it says that they have to have:
I was curious, so I popped on over to Salary.com and typed in “Registered Nurse Anesthetist” in my own zip code for a base salary search. I found that they start out at $131,000 and top out at over $170,000 in my local area.
Then, after giving serious consideration to changing this blog from “Life Under the Lights” of Fire Trucks and Ambulances to “Life Under the Lights” of an Operating Room, I decided to point something else out about the differences and similarities of a Paramedic and a CRNA.
“The didactic curricula of nurse anesthesia programs are governed by COA standards and provide students the scientific, clinical, and professional foundation upon which to build sound and safe clinical practice. The basic nurse anesthesia academic curriculum and prerequisite courses focus on coursework in anesthesia practice: pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry (105 contact hours); anatomy, physiology, and pathophysiology (135 contact hours); professional aspects of nurse anesthesia practice (45 contact hours); basic and advanced principles (sic) of anesthesia practice including physics, equipment, technology (sic) and pain management (105 contact hours); research (30 contact hours); and clinical correlation conferences (45 contact hours).
Most programs exceed these minimum requirements. In addition, many require study in methods of scientific inquiry and statistics, as well as active participation in student-generated and faculty-sponsored research.
Clinical residencies afford supervised experiences for students during which time they are able to learn anesthesia techniques, test theory, and apply knowledge to clinical problems. Students gain experience with patients of all ages who require medical, surgical, obstetrical, dental, and pediatric interventions. The results of a 1998 survey of program directors show that nurse anesthesia programs provide an average of 1,595 hours of clinical experience for each student.”
(Again, from http://www.AANA.com – the emphasis is mine)
Remember that the CRNA’s have a Bachelor’s Degree and a RN license prior to beginning their training. This is different from the Paramedic curriculum. We have hour requirements as well:
“The emphasis of paramedic education should be competence of the graduate, not the amount of education that they receive. The time involved in educating a paramedic to an acceptable level of competence depends on many variables. Based on the experience in the pilot and field testing of this curriculum, it is expected that the average program, with average students, will achieve average results in approximately 1000-1200 hours of instruction. The length of this course will vary according to a number of factors, including, but not limited to:
-student’s basic academic skills competence
-faculty to student ratio
-student motivation
-the student’s prior emergency/health care experience
-prior academic achievements
-clinical and academic resources available
-quality of the overall educational program”
(Source: Http://www.EMS.gov – Thanks to Chris Webster, Sam Bradley, Greg Friese and Kevin Reiter)
Not that the above is related to the article I read, I mean it’s saying that people with a BS degree in something, a medical license, and what amounts to a little more than an EMT-B class plus an EMT-P class from an accredited school make an average of $150k… but I digress.
Back to the article, Dr Rein has this to say about CRNAs:
“It is interesting to note that the United States is the only westernized country in the world that allows nurses to administer anesthesia unsupervised. Countries such as Canada, Australia, New Zealand, Japan and Israel, just to name a few, have no nurses administering anesthesia. In some European countries there are a few nurse anesthetists who work under the strict supervision of a physician.”
He continues and says this:
“So what’s up with us? Well, it seems that the American Association of Nurse Anesthetists have convinced our government in Washington that unsupervised nurses are just as safe as a physician. They point to the fact that there are no comparative studies to show they are not. The reason there are no studies is that it would be unethical to perform such a study in which some people get a physician and some do not. Can you imagine a patient agreeing to participate in such a study?”
Can you imagine indeed?
Dr Rein is right when he says in the letter that Anesthesia is a Medical profession and is a specialty of physicians for a reason. When he says “Just because we have made it safe is no reason to take it for granted”, he’s right as well. Anesthesia is dangerous for the untrained and inexperienced provider and it is a specialty not to be taken lightly. However, where’s the line? Is this an attempt by the”Virginia Anesthesia and Peroperative Care Specialists” to fire a shot at the “American Association of Nurse Anesthetists?” Are Doctor Anesthesiologists afraid of losing jobs to the nurses? Where is the line where patient safety is best maintained while being most cost-effective and efficient?
If this doesn’t provide incentive to you to think about requiring a degree for Paramedics, I don’t quite know what will. I’m not doing this job for the money and neither are you, but does that make us any more or less moral than a CRNA who “Isn’t doing his/her job for the money” either, but still makes a ton more of it than any paramedic I know?
You could change the names of the players in this argument, fiddle just a bit with some of the details, and change this into one of a thousand other feuds going on under the healthcare umbrella. This is the same story that paramedics face when we’re trying to get new skills, new techniques, more money, and more responsibility. While I’m not taking a stand on the CRNA/MD issue because it’s not my specialty, I’m offering up this debate as a study in professional growth and conflict between two of the myriad of medical camps out there. As we push EMS forward, grow as a profession, and promote the EMS 2.0 agenda, learning from things like this will be of value to us all.
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Thanks to the following for their contributions:
But when I do, they’re usually of the macro-local type and have something directly to do with EMS.
The village of Schaumburg bucked the national trend of raising taxes and fees to cover rising expenses when its board unanimously approved a 4.4 percent reduction to the 2010 property tax levy
You read that right: reduction.
But that’s not all. Village officials also did away with vehicle sticker fees and moved to have property taxes cover garbage removal.
Just for the record, Schaumburg is in Illinois, folks. The same state that sent our senator up to the White House last election cycle. Lowering taxes isn’t exactly the modus operandi for an Illinois municipality. In fact:
Schaumburg is an anomaly among Illinois municipalities. Others like Gurnee and Orland Park raising taxes and fees where ever they can. Northbrook, which has seen an increase in sales tax revenue stood pat.
Schaumburg is one of the larger municipalities in the sprawling conglomeration of suburbs surrounding Chicago. It faces the exact same economic challenges that other municipalities in the area face, but it seems to be doing much better, economy wise.
The measure, if you read the article, isn’t final, but it looks like it will pass. Schaumburg has a full-time Fire/EMS dept and pays their firefighters extremely well, they also seem to have great city services and every time I’ve been in the city I’ve liked what I’ve seen.
In fact, the recent NAEMSE conference was held in a hotel in Schaumburg, and they played a small part in paying the hotel tax.
As I’ve said before, I’m not one to wax too poltical on this blog. This is an EMS and Fire blog and you come here to read about things related to Fire and EMS. I understand that. I don’t want to hijack the discussion to the miasma that is our national political scene and end up alienating a different percentage of my readership every time I post something of an opinionated political nature. However, local politics affect EMS and Fire, and I speak on the politics of EMS quite a bit. This is one of those issues.
I have to ask the question here:
Businesses pay taxes, residents pay taxes, Visitors pay taxes… It goes to say that the more businesses, residents, and visitors a locality gets, the more taxes they’ll pay by sheer volume. People have a choice on where they locate their business, where they visit, and where they choose to live. If you were in the position to do any of these things, knowing that Schaumburg is lowering their taxes, and plans on removing their property tax entirely - just like they said they would – would you choose to do so in Schaumburg, or in the other towns mentioned in this article?
In additon, removing the stupid municipal car stickers, which are really just a massive inconvenience and hassle to the residents of a city, and covering garbage disposal fees through what’s left of the property tax?
Well, Schaumburg… you may just be an island of sanity in an insane state. May word get out and people flock to your borders. It’s called “competition” and usually only successful businesses are the groups that think of lowering their prices to become more attractive to the customer. Bravo.
I’ve always said that I love EMS and that I’ve taken from it far more than I could ever give back to it. The same is true with this blog. From my readers and people who comment, I learn more than I can teach and enjoy more than I can entertain.
This weekend proved all of those facts quite well.
If you didn’t read the blog over the weekend, you missed an amazing discussion on my last post. The post, “A Weighted Issue, The Fire Service Helping Private EMS” discussed the case of a private ambulance requesting a fire department for assistance in carrying a bariatric patient back into her home on a long-distance hospital discharge. The private ambulance was 5 or 6 hours out of their area of operations and the Fire Department was a full-time municipal department.
I linked to the stories that had popped up on www.JEMS.com and also on www.EMS1.com. I wrote my feelings on the issue, explored the case a bit, and then opened up the floor to the readers for their comments.
And what happened floored me, just knocked me over.
Predictably, I started getting comments on the post… Then some more… then more.. then a LOT more.. then a TON more. The post spread like wildfire and attracted some of the most intelligent discussion I’ve ever had here. It’s by far my most commented post with 86 at the time I write this.
And I read them all. I love comments, they come to my BlackBerry. Really. I read the discussion, the back and forth, and the wide spectrum of opinions as they came in, sometimes two and three at a time.
And my opinion has been swayed… my original perception that the Fire Department was Evil has been tempered. My original perception that the Private Ambulance could have dropped a dime and handled the issue with a phone call before the incident has not changed. However, I now focus my ire on the system that caused this issue.
The reimbursement structure holds the ambulance service hostage. No private ambulance would be reimbursed for hauling the patient with extra people. The service wouldn’t have been reimbursed for a 2nd rig and the patient had to be taken home. My guess, as was stated by a handful of commenters, is that the service was taking the patient as a favor to garner more business from the rehab hospital. I have no way of knowing that for sure, but it makes sense to me.
Not only did I get a TON, just a ton of great discussion… but the post spawned a few others as well.
This event has taught me something that should be the takeaway for us all. That is this: Issues like this are not going away. In fact, they’re only going to get more common. Private EMS isn’t evil and the “Private Transport Industry” is necessary for the functioning of our healthcare system. Fire-Based EMS will have to help and could never handle the strain of not having private EMS.
Sorry to both parties here, we’re all needed in the current system. Healthcare needs us all.
So play nice and help each other out. Remember the Golden Rule.
And remember the five P’s: “Proper Planning Prevents Poor Performance”
I shall leave you with two things:
http://lifeunderthelights.com/2010/09/a-weighted-issue-the-fire-service-helping-private-ems/ – A link to the post for you to wade into the comments if you haven’t (you should. Bring a snack)
And this, a video that this experience has brought to my mind. “The Hats of Incident Management” It’s about highway incidents… but you’ll get the point. It’s a classic.
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Howdy Everyone!
This is your friendly neighborhood paramedic-turned-writer Ckemtp here with:
An Important Announcement
As part of my continued struggle through my capitalistic tendencies, I have decided to offer a suite of services to those who may want some sweet services. (see what I did there? The pun? Funny, right? Yea.. it’s funny) You can find those services above the post in the navigational bar.
Yep, right up there in the middle. The “Services I Offer” button.
Want me to write for your organization, speak for your conference, or ginzu up your data?
Here’s your chance.
I wanted to put something up here about 9-11… but I’m having trouble coming up with something new.
Last year, I wrote a piece called “Moved to Tears”.
Even though it’s last year’s post… I’d say that it’s still relevant and I don’t think that anything I write today is going to be any more poignant.
Never Forget. Never Appease.
When you could be reading Happy’s explanation of EMS @.0 over at the Chronicles of EMS website?
Go read it. Print it out please, and share it with the world.
http://chroniclesofems.com/ems-20.htm
Thanks, Happy.
Medic trommashear has written her part of the co-post about sadness in EMS. It’s a story that one just can’t help but get choked up over…
Just read it:
Medic Trommashear, who writes great stuff has offered to co-post with me on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/
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This morning the wife came home from her night shift on the ambulance and told me a sad story. During the wee hours of the morning she handled a rather nasty fatality accident. The victim, a 20-something male was walking home from a party on a dark country road and tragically, a passing motorist didn’t see him in time and the accident ensured that he’d never make it. Pedestrian vs. car accidents at high speeds have a way of doing that.
Sad stories like this are getting more common for her as she’s immersed herself fully into paramedic school and professional EMS in general. She’s been seeing sad stuff multiple times per week it seems. I can see that it’s wearing on her and I feel her pain. I have experienced it quite a bit myself in my own career and I continue to do so on a regular basis. Jumping into full-time EMS exposes a person to sadness on a level that can’t easily be prepared for. A person just has to jump in with both feet and not be afraid to feel the range of emotions that they’re going to be exposed to. It’s hard, it’s tough, and it’s one of those things a person just has to learn how to overcome if they want to make EMS a part of their life.
That’s the part that most people don’t get, I think. The part where you have to “Learn How” to overcome the sadness and negative emotions we’re faced with as EMS people. A common statement that lay people make when they hear that I am a paramedic is “Oh, I could never do that job and see what you see. I just couldn’t handle it”. Perhaps they’re right, but I would guess that anyone can train themselves to handle almost anything. My pseudoscientific opinion is that we develop our tolerance and our healthy ways of dealing with being exposed to such negative emotions on a regular basis through experiencing it and learning ways to function and feel happy afterwards. It’s harder for some than others and I can’t imagine that there is a single roadmap for learning it. It’s individual. Friends help and so does an understanding family. Good coworkers are great to observe and learn from as long as they realize their own humanity and aren’t simply trying to fool themselves out of bravado. We’re all human and I can testify that we’re all affected, no matter how thick our skin may appear.
Back when I was a new medic I was working a ton of hours. I mean, I worked a lot. I worked TOO much. I worked for days on end without sleep for multiple jobs. At the time, I felt I had good reason. I was attempting college for the first time, taking care of my recently deceased father’s businesses, and trying to sock away money to help my mother. I worked a full-time EMS job, a full-time hospital job, ran the businesses, and volunteered for a separate fire department and EMS agency. It was nuts. I would literally go for days without sleep. During that time it seemed like I was getting slammed by horribly sad calls. I felt I was surrounded by suffering and death. I was working at least two codes a week on average. Mayhem and madness seemed to rule the day. I was getting deeper and deeper and…
I was going nuts.
I was horribly, deeply depressed.
I almost went insane.
I was at my darkest hour when I found myself angry at anything that was cute or fun. Literally things like jokes, teddy bears, and Hallmark cards made me angry. I just couldn’t see how people could stand to look at that kind of stuff when there was so much suffering in the world. How frivolous! What a waste of time! It made me angry to think of anything that didn’t acknowledge the pain I was bearing witness to on such a regular basis. I was depressed and angry. I just couldn’t understand anything other than feeling the pain that the people I was taking care of were feeling. It affected my life, my work, and my human interaction. It was horrible.
Then I had an epiphany that changed my personality and who I am to this day.
Those who meet me know that I like to joke around. A lot. There are things that I take seriously however I do not personally happen to be one of them. My epiphany was that the stuff that was cute, fun, loving, friendly, and/or happy was all that actually did matter in life. We combat the bad with the good, the yang with the yin. I chose to pay attention to the comedy of life and downplay the tragedy. After that revelation, my whole outlook on life and my personality changed for the better. I had found that comedy, friendship, and love were the ways to live my life. Come what may, I can make a joke about it and that makes it ok. I laugh at inappropriate times and seek out the good in life. My life and career ensure that I’ll still have an onslaught of human tragedy thrown at me whether I’m ready for it or not but If I can actively seek out the positive, I may just end up ahead of the game.
To my wife, I love you. Hopefully you don’t end up where I have been… but I’ll be here for you, come what may. I understand what you’re going through and I love you for this any many, many other reasons. Always.
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You may want to read one of my most popular posts. It’s an older post of mine where I explore what I call “Splashed Sadness”. It’s along these lines. We EMS people have to deal with a lot. Never be afraid to share it. Don’t hold it in. Get it out and learn how you can cope with it because there’s not a one of us ain’t human.
“Splashed Sadness – A look at Negative Emotions in EMS”
Or “Reflections on an Easter Morning” – another post about a bad call.
Also, don’t forget to check out Medic Trommashear’s co-post on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/
(Note: I’ll link to the post directly when it’s up)
This is a coordinated post by our friends Greg Friese and Steve Whitehead.
- Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628
- Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/
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“They Don’t Know What They Don’t Know”
It’s an established fact that 60% of fatalities within confined spaces are would-be rescuers. They see someone down in a confined space, enter the space, and are overcome by the conditions that took down the initial victim. The process sometimes repeats itself, with multiple would-be rescuers entering the space and falling victim themselves. It’s tragic really, but the cold, hard fact is that these people are victims of their own ignorance. They don’t know what they don’t know. They don’t know that there is a fatal set of conditions within the space, and they don’t know that whatever it is that killed the first victim, or subsequent victims, will kill them as well. It’s a well documented phenomenon that plays on the compassion of the would-be rescuers and ends up getting them killed.
They simply don’t know what they don’t know.
Hey Guys?? Guys?
So when I was approached by our friend Greg Friese from www.EveryDayEMStips.com the other day regarding a comment he received on one of his training articles, I was interested in doing a co-post with him. He also has contacted our friend Steve Whitehead from www.TheEMTspot.com and together we’re tri-posting on this issue. Their links will follow below and are just great as always.
The comment that followed this online training article was written presumably by a paramedic. It was a critique of the article that simply stated “too much information for a paramedic”. I read that, and immediately thought of confined space incidents, where ignorance can get a person killed. Lots of situations fit that scenario and it’s not always the rescuers who get killed. EMS providers who “don’t know what they don’t know” can and do kill patients. More often, they don’t provide the best possible care.
There’s this thing that we have made it our business to know how to repair. It’s called the “Human Body” and if you’re reading this article, the chances are good that you possess one. The human body is VASTLY complex. It’s the most complex machine we humans know about and we are still learning about it to this day. There are some amazingly smart people out there who have dedicated their lives to studying these meat machines that our brains pilot around and they still haven’t figured everything out yet. We can help set it back on course to heal itself in a lot of cases but we can’t construct a new one. We don’t know about all the minutia, the microscopic works inside of it that make it do all of the amazing things that it does. The levels of systems within systems that function seamlessly within still other systems are numerous and fascinating. I learn something new about it all the time, and still there are people who know vast amounts more about the inner workings of it and about the huge number of things that can affect it’s operating effectiveness than I do. The human body is remarkably complex yet elegant and perfect in its design.
C'mon... Don't be a wuss.
And we who call ourselves “medical professionals” are well advised to study every possible aspect of it. Consider it your “life’s work”. If your job is to fix and support the end users of the human body, you darn well better know everything you can about it.
“But”, you say, “There are people out there who are supposed to know much more about the human body than we are. They’re called Physicians, and they get paid a whole lot more than we do. We’re just paramedics. (or EMTs).” And you’d be right for saying that, of course. Physicians have the ultimate responsibility for knowing the human body. It’s their life’s work as well. Their patients live and die based upon their knowledge, skills, and talents they have for examining the human body and being able to figure out what’s going on. Their whole practice is based upon their knowledge, skill, and talent. The more they know when they’re working there, the better provider they are.
It’s that simple, and it’s exactly the same for us EMS people. The more we know, the better we are. Nobody is better served by dumbing us down. Nothing is gained by denying yourself knowledge. Not a single patient is better served by you not knowing everything you can know about what is going wrong with them and it’s your duty to learn as much as you can about what you’re supposed to know about.
What is the line for how much paramedics “need to know?” Is everything that we need to know covered by our initial training course? Is that everything we need to get out there in the world and start slinging IVs and Meds all willy nilly?
I look at the paramedic license as a “learner’s permit”. It’s the baseline knowledge level needed to function at that level under supervision. It’s a jumping off point from which the provider should immerse themselves in knowledge. I can certainly say that I’ve learned volumes past my initial certification and that the “extra” knowledge has saved lives. Did you know that Fentanyl can cause chest muscle tetany when administered too rapidly? Or how about that lasix, when pushed too rapidly can cause hearing loss? Do you know that ST depression in the high V leads can signify a posterior MI? What about differentiating an acetabulum fracture from a “pulled groin”? Can you reliably predict the patients whose blood pressure is going to crash after Nitroglycerine administration by reading a 12-lead EKG? What about the clinical presentation of a non-ST elevation MI? Do you know the MEND stroke screen? What about the different neurological exams to find an intracranial bleed?
Etcetera, etcetera… The point is, there isn’t a cut off. The final exam we take for our licensures prepares us with the baseline knowledge to get out there and learn what it takes to make us truly great EMS providers. The true professional will learn this, and constantly seek the knowledge he or she needs. The average to sub-average provider will comment that they “don’t need to know” something.
Get out there, get fascinated, and learn as much as you can. It will never be enough knowledge… but your mind is a sponge for a reason.
Study Hard. Know Your Stuff. No Excuses.
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This is a coordinated post by our friends Greg Friese and Steve Whitehead. Be sure to read their posts on this
Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628
Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/
This just in from the City of Brotherly Love:
http://citypaper.net/articles/2010/08/19/blogging-business-privilege-tax-philadelphia
Apparently, they require all small businesses to pay for a $300 “privilege license” in order to operate. Apparently there are no exceptions… so bloggers?? Pony up the three Benjamins or be in some big trouble.
I am SO going to rush to Philly and start a business there now! I mean, if I had to choose a business friendly economy to start my small business in, I’m just so sure that I’d start it in Philly! This will do wonders for their economy, I’m sure.
<sigh>
Not too long ago I was reading an article in Entrepreneur Magazine when I came across an article speaking on negotiating tactics. I wish I could find it, but unfortunately it was long enough ago that I’ve disposed of the printed issue (I subscribe) and cannot find it on the web. It was a good article and it taught me some words that I’ve since used quite a bit in my own life:
“Is that the best you can do?”
From the time our parent’s first put us out there in the world most of us have probably been told to “Do our Best” when we try to do something. No matter if we win or lose, we’ve been told that it’s ok as long as we “do the best we can” while trying. We seem to feel better at the outcome of almost anything if we feel that we’ve “Given our best shot” when we try to accomplish what we’ve set out to do. We all like to do our “best” and we hope that our “best” will be good enough.
This begs the question… is what you’re doing today in EMS “the best you can do?” Career wise, operationally, with your service’s treatments, with your own personal training and education, and with your own attitude… is this really “the best you can do?”
I would like to think that I “try my best” in my own EMS career and paramedic practice. I would also like to think that I work for an EMS organization that is trying to do the best it can for its people and its collective patients. However, there are quite a few situations where I have felt that I have not done or have been prevented from doing my best for a number of reasons. Some are reasonable and others are not. I’d think that all of us would give the answer that we always want to provide every patient with our “best” possible care. However, I’d also guess that everyone reading this can think back to any number of situations where they feel that they didn’t give it. Sometimes this reason comes down to the skill set of the individual provider. This could be a situation where the provider didn’t have the best possible information or knowledge available to them. They may have provided an ineffective or even harmful treatment modality or might have failed to act upon a missed assessment finding, such as by giving a medication for which a patient has a documented allergy because the provider didn’t know or simply forgot that the patient had the allergy. Sometimes the actions of others in the organization can prevent a provider from rendering the best possible care. This could be by failing to check, clean, or restock a needed piece of equipment or by providing inadequate care prior to a provider assuming patient care such as in the case of a first-responder crew failing to place a patient in full c-spine precautions when indicated prior to moving a patient to the transporting ambulance and the transporting EMT not having enough manpower to safely immobilize the patient. Sometimes the organization can hinder an EMS provider from doing his or her best by doing things such as providing inadequate equipment or medical protocols, or by mandating that a provider regularly work past exhaustion-level hours.
People inherently want to do well at whatever they choose to do for their careers as well as at other tasks where they feel strongly about the outcome. I may have accepted that I’ll never be as good of a basketball player as Michael Jordan, nor the same-level of cartoonist as Scott Adams, nor the best noodler in the world… but I’m certainly going to try to be the best paramedic I can be.
THIS guy, however, may be The Best Noodler In the World
Sometimes our own personal biases prevent us from doing the best we can do and for this I’m not talking about bias regarding any protected classes or topic, rather I’m talking about our own version of the status quo. A personal example of this would be my ALS Quick Response Vehicle at work. We went a solid week without having the proper forms available for the daily equipment checks and I didn’t have the computer access to print more off. During that week, I got in the habit of not using the forms and simply checked the truck based upon my knowledge of what was supposed to be in there and what was supposed to be checked. The way it played out, I ended up continuing to not use the check sheets when checking the vehicle, even though the forms had been replenished. A few weeks later, someone found that there was equipment missing in the vehicle that had gone unnoticed for some time. At that point, I realized that I had developed my own bias against using the forms for a reason that is even unbeknownst to me. I had gotten in the rhythm of not using the forms, and that caused me to miss that the infrequently-used piece of equipment was missing. I had developed a personal mental bias that prevented me from “doing my best” and thoroughly checking the truck.
Another preventer of best practices can be organizational politics, both internal and external. As a paramedic who regularly responds to other ambulance services to provide “ALS Intercepts”, I have observed that the politics between the services we work with can affect patient care for both the negative and the positive. While I am not saying that any of these arrangements result in inadequate patient care, I can say that the services with whom I interface most frequently and most pleasantly get a better provider out of me than do the services with whom my relations are less frequent or are strained due to political turmoil. When I respond to a request for an ALS intercept, I am being called to the “house” of another group of providers. While I am the highest level of care on the scene, I’m also a guest in their house. They have their own internal biases and I have mine. Sometimes the synergy in our working relationship can be strained, which results in a palpable difference in the flow of the scene and the teamwork exhibited at it. While I will ensure that I “do my best”, it’s easier to do it when I work well with the team I’m working with.
So how do we change things? We’re all human and we all have things that prevent our “best shot” from being the only thing that we “give it” in our EMS careers. This may be consciously, as in the case of internal politics; Subconsciously, as in the case of my not using the check sheet; or Involuntary, as in our service not providing us with needed equipment or our coworkers failing to replace an item in the ambulance that we did not have an opportunity to check. As in most things, the easiest thing for us to change is ourselves. Changing ourselves is a great place to start and will make serving as an example to others your main tool to use to try and get the best out of them.
Most situations can be made better and almost all of us can try harder. The secret is to attempt to do our “best” at all times and to try and ingrain our own best practices into our daily routines. This can be as simple as always trying to check the truck in the most thorough way possible or by making sure that you always check and recheck things to ensure that they’re done right. It helps to continuously seek out and recognize one’s own personal biases, (remember my check sheet?) to make sure that our own preferences and routines aren’t leading to suboptimal performance. Consistently ask yourself if what you’re doing is the “best you can do” and then ask yourself what you can do to make it your best. Mentally prepare yourself for your shifts with adequate rest when possible, manage your stress level so you can keep your thoughts focused on your care, and train hard. Ingrain your best efforts into the systematic way you do things and make your best way your normal way of doing things. We can’t change everyone around us in an instant, but our quiet positive efforts can pay large dividends in how people around us think, feel, and act. Our best may in turn get the best out of our partner, which may in turn get the best out of the next crew, and so forth. Soon enough… deciding to give our best may change your organization, our industry, or our profession.
And I assure you, doing your best will indeed make the difference in someone’s life. It’s just what we do, Folks.
“Is that the best you can do??
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For more on doing your best in EMS and in getting the best out of your EMS people read: “The Shine Factor”
There’s just no way to say this: I’m friggin excited!
There’s a chance… a chance that one of our long-lost-friends may be returning to our daily… ok, well twice or thrice weekly, lives..
Go read this: http://999medic.com/2010/08/18/there-is-a-chance/
(Woooooooooooo HOooooooooooooooooooo!!!!!!!)
http://www.facebook.com/CoEMSonDiscovery
See that link up there? That’s a link to a facebook page that’s been set up in support of our friends behind the “Chronicles of EMS”, which if you’ve been living in an EMS-less cave lately is the reality show being put out by our friends The Happy Medic, and Ted Setla.
They’re trying to get people to “like” them and write some reasons why the Discovery Health TV network should pick up the show.
Would you please? (http://www.facebook.com/CoEMSonDiscovery)
Yes, that’s an order.
What a week! You’ve been pulling at least a double shift a week at your full-time ambulance job and have been hitting it pretty hard at your part-time job as well. Both services can’t seem to keep their schedules filled and everyone’s been working lots of hours in order to keep the doors going up and the trucks going out. To top it all off, the citizens just can’t seem to be good lately and both services’ call volumes have been high.
You were tired when you got up this morning and were seriously considering a nap after your morning shower, but after a gallon or two of coffee you were bright and shiny in your uniform at your station, ready for another day of EMS greatness.
That was five hours ago though, and the early barrage of calls fired at you this morning has turned into an afternoon lull. Now you’re sitting at your main station, close to the brass, with the words in the educational article you’re reading fading in and out of your bleary, cross-eyed vision. Since the activity level has decreased, you’ve gotten yourself a case of the sleepies that you just can’t shake. Since you’ve been consuming the steaming bean juice religiously lately, your stomach just won’t let you think of having another cup of the acrid station coffee and there’s no shift chores left to do, since you did them an hour ago fighting the same lethargy.
Unfortunately, in three hours you can see a long distance transfer scheduled that you’re probably going to have to do. Four hours of monotonous highway driving and the radio in the truck doesn’t have that great of reception. You don’t have any idea how you’re going to stay awake enough to drive the truck and that’s not even considering the fact that if the tones went off right now for an emergency you probably wouldn’t remember how to put on a band-aid, let alone remember a drug calculation.
You’re tired, you’re fatigued, and your body’s telling you that you’ve been pushing it too hard. It wants to shut down for a while. Your brain won’t think. You’re mouth won’t talk. You can’t keep your eyes open and wake up with a startle when you’ve realized you’ve dozed off for a bit. This is torture.
Sleep deprivation is no stranger to EMS people. We’ve all fought the lethargy caused by long 24, 48, and more-hour shifts. A great number of us work more than one job to make ends meet and pack as much family time and recreation into our off time as we can. A lot of us are going for more education and all of us get woken up from our sleep a lot more often than is healthy to run on calls. I regularly miss full nights of sleep and rarely have a night when I can say I got a full night’s sleep. We get use to it some of the way, but our bodies just aren’t meant for chronic sleep deprivation. We need to reset and reorder our brains and let our bodies recharge once in a while.
Unfortunately, our communities need us and we have to be there for them. EMS is important and it’s easy to get sucked in.
That’s why in this situation, I have very little dispute with taking a “Safety Nap”.
"SSSS-AAAA-FFFF-EEEE...."
The “Safety Nap” is a quick power nap. A shut-down and reset period where a person who never knows when they may be called to be up all night without sleep can rest and relax for a while and ensure that they’ll be wide awake and alert for whatever they may be called to do. I took an hour last shift around 3pm as a matter of fact. I didn’t get to sleep until 1am afterwards and I was up at 5am for a call. EMS is like that, shift work is like that. We have to ensure that we’re well-rested enough to make quality decisions of the type we have to when they need to be made… and we can’t do them well when we’re drooling on ourselves from exhaustion. One of Murphy’s laws for EMS states that “You know you’re in EMS when your favorite hallucinogen is sheer exhaustion” and I have to tell you, I’ve done that while on duty before. It’s just not safe.
There are problems with this, I know. Some will say that we shouldn’t allow ourselves to be scheduled this many hours and that it’s irresponsible to do so. Well, then they can come talk to my bosses and pay my mortgage. Some people will sleep all day if they let them, and won’t put any effort into their shifts unless they have to. That has to be monitored. With that said, a balance has to be sought. I see nothing wrong with the occasional safety nap and I believe that EMS managers should allow it. They also should be unafraid to throw a cup of cold water on the Rip Van Winkles among us to ensure that they pull their weight with the non-call-response aspects of an EMS job.
What do you think? Does your employer allow “Safety Naps”? Do you take them?
I’d write more but Zzzzzzzzzzzzzzzzzz
Howdy Everyone!! It’s Ckemtp, your friendly neighborhood EMS and Fire blogger with a few things I’d like to bring to your attention. I’d like to talk to you today about politicians. Not the politicians that are doing such a great job at managing our collective money on the national level… I want to talk to you today about the local ones, the ones who do the important work of making sure our traffic lights aren’t burnt out, that our roads are pot-hole free, and that our sewer systems don’t back up and discharge raw sewage into lakes and rivers and stuff.
Specifically, I’d like to talk about Local Politicians and public art.
My favorite writer, the legendary Humorist Mr. Dave Barry, wrote a piece about public art a few years back that you just have to read before continuing on with this post. It’s actually one of many of his articles that include things about public art, which he defines as “Art that is purchased by experts who are not spending their own personal money” it also involves the phrase “a naked man the size of an oil derrick” and has references to nuclear weapons and alcohol. I love Dave Barry, I really do.
Read this: “Does Public Art Make Sense” – Then come back once you stop ROFL’ing
This is "Art" I think... Oh I know! It's a bus stop
Then, g’head and read THIS ARTICLE from Michigan Capitol Confidential which talks about the REALLY SMART city of Ann Arbor, Michigan… which is planning an $850,000 piece of public art. It’s really interesting to me that they’re planning this… and I really hope it isn’t made of flammable material because the city is “Facing a multimillion dollar budget deficit” and is planning on laying off firefighters to handle the budget crisis.
Here’s that article again: http://www.michigancapitolconfidential.com/13219
Yes, Ann Arbor, MI, the REALLY SMART city that it is, is laying off firefighters while spending $850,000 (That’s EIGHT HUNDRED FIFTY THOUSAND DOLLARS) on a “three piece public fountain”.
Oh, right… if it’s a fountain, it probably won’t burn down. That makes sense. Of course it might get filled with trash, since they’re laying off the city’s “Solid Waste Coordinator”. Y’know… the guy who oversees the trash pickup for the city. On the other hand though, they are hiring an “Art Coordinator” to, I don’t know… look at the art maybe? Maybe he’ll pick up the trash from the fountain.
Taxpayers, I’m talking to you here. Inefficiencies and, in this case, abject stupidity in local governments are killing us. If I was having trouble keeping up with the maintenance and mortgage in my own house, the first thing that I would do would not be to buy new paintings to hang on the walls. I certainly wouldn’t buy paintings at the expense of paying for trash pick-up, sewer service, or portable fire extinguishers. I think that I would pay for necessities first and niceties second. Responsible people take care of the whole Maslow’s Hierarchy of Needs thing; Food, clothing, and Shelter first and buy pretty things after that. You do the things you HAVE to do well before the things you’d like to do.
At least responsible, SMART people do that… and apparently that’s not the kind of people that the voters in Ann Arbor, MI think would make good city council members.
Or do they?
Maybe they can call this "Art"
By now you’ve all heard of the flap that is happening in Mass. regarding the 200 or so EMTs and Paramedics that had their licenses suspended or revoked for running a non-existent training program or for falsely representing that they attended non-existent training classes. If you haven’t heard about it by now, you’re probably not following EMS news as much as you should.
Here is one of the articles on the subject from JEMS.com
The issue has been discussed quite a bit around the EMS blogosphere. Some big name bloggers have written on it, and I even discussed it a little bit on the EMS Educast the other day.
Here’s TOTWTYTR’s take on this: I’m Not Very Sympathetic
And here’s Rogue Medic’s take on it: (this is a part-2 that reiterates the first)
Here’s the episode of the EMS Educast where we discussed the issue briefly
Other than for speaking about the issue briefly, I’ve been avoiding writing on it. My job is usually to report positive things that are happening in the EMS world and this is definitely not a positive thing. In fact, it’s a disgrace to us all. Rogue Medic has it right when he asks the question “Why do we Encourage such apathy in EMS?”
And that’s what this is. It’s not just that it’s apathy for the boring destruction of brain cells that we call “Continuing Education” in most areas of EMS, it’s the apathy for the whole process. The apathy where we as a profession have let the standards get to this point.
I mean, really. How many of you feel that the continuing education you receive is anything more than something you have to do in order to keep your license up? How many of you feel that your regularly scheduled, mandatory, continuing education classes are of any quality? How many of you feel like they’re actually doing anything good for you?
And that’s the system in which we function. TOTWTYTR made the statement that he sits through boring traning classes all the time because those are the hoops he has to jump through in order to maintain his licensure. I do too, of course. I sit through probably as many or even more classes than anyone reading this article because I am a practicing paramedic with National Registry and licensure in three states. Sometimes the training from one state carries over into the next, and sometimes it doesn’t. At any rate, I get to listen to unmotivated speakers read flat material whilst sitting in an uncomfortable chair on a very regular basis. We all do.
However, I feel that I keep up my continuing education quite well on my own through other means such as extensive self study and non-credit medical education. Keeping my professional skills sharp is very important for me because not only am I proud of my professional skills, but I am well aware of the fact that the quality of my skills translates into the quality of life for my patients. If I keep myself sharp, I’m a better paramedic. If I let them get dull, well then I’m an apathetic paramedic who isn’t doing my duty. Duty is important to me. So are things like Pride, Professionalism, and Honor. In fact, those three words are more than just the slogan for my blog, they are how I think that I and other EMS professionals should live their lives and careers.
Others have been quick to demonize the 200 suspended EMTs. Others have been quick to defend them. The ones defending them have said that these people are apt to lose their incomes, their livelihoods, and that the punishment is unfair. Well, for that part I disagree. The punishment is indeed fair. You could have killed someone by being untrained oafs with lackluster skills. You never proved you were otherwise. However, if you were to ask me if I thought that a state EMS agency – ANY state EMS agency – was competent to manage such a program, I would laugh at you. Every state has made an attempt to regulate continuing education and I agree that there is a good reason for them to do so. I would also agree that the prospect of regulating a group of EMS people in their continuing education efforts is a daunting task. I would say that the perfect system has yet to be developed and that a good number of the 200 were simply “playing the game” and thought that since their states EMS continuing educational system was a joke that they could make a joke out of it as well.
Here’s the most biting apathy of all to me. If you believe that a system that you work under is a joke. If you believe that there is a better way to do something. If you believe that what you’re made to do is pointless and obsolete… then why the heck haven’t you done anything about it?
I’d like you to look at this issue from this perspective, folks. Sure, not everyone in that group of 200 were caring, competent professionals. I’m sure some of them were jackasses. (And yes, I said “Jackasses). However, I’m also sure that there is a percentage of them in that group that sincerely care about being the best they can be in EMS and they simply got caught up in the mob mentality. I’m sure that some of them had just given up. I’m sure some of them were good people who just became apathetic.
I hate apathy.
If what, say 50% of that group were of the caring kind, that leaves 100 people who thought that the system was broken. Did it not occur to any of those 100 people to try and change it? Did they not try and band together to improve the system? Could one person do it? Could 100 people do it?
If we are to be regulated and controlled by obsolete and ineffective bureaucratic systems, then it is our duty to rise up and change things. Sure, that sounds melodramatic… but how many times have you thought that your state regulations were stupid. One of the defining aspects of a Profession is Self-Regulation. Look at your states “Bar Association” for Lawyers, or the states “Medical Association” for physicians.
Is there any state out there that has a “Paramedic’s Association” that has any teeth to it?
No continuing education system or relicensure processes is even close to perfect. That’s because of a few reasons, not the least of which is because the government is the one running it. The other reason could be because it isn’t being policed by the paramedics who care about it the most.
I’ve said it before, I’ll say it again. It’s time for us to take ownership of our profession. Stand up and make this the profession it deserves to be. Stamp out apathy and band together to let your voices be heard. If you don’t start the process of meaningful change, who do you expect to do so?
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For more positive discussion on EMS, check out the comments section in “Negativity? You Won’t Find That Here” or for a description of two real-world moral and ethical dilemmas in EMS, check out “Two Cases, one letter. From one paramedic’s struggles, change can come”
If you would think back a few months ago, you might faintly remember a controversial streak that I had where I posted a few hotly debated topics. One of those posts: Saved By the Bell? High School Student EMS gathered a LOT of responses, both in my commentssection and on the JEMS Facebook Fan Page.
The post looked at whether or not it was a good idea to begin Emergency Medical Technician (EMT-B) training in High Schools and also whether it was a good idea to have high school students actually responding to emergencies. My take was that while I support the idea of first-aid, CPR, and even First-Responder training in high schools, I think that holding EMT-Basic level training there is a bad idea. My thoughts were also that having high-school students responding to 911 medical emergencies was absolutely coo-coo insane.
Depending on your views, I was either a mean and grumpy old man who doesn’t understand just how special these kids are or I was taking a stand to save the profession from the further watering down of our educational standards, professional competency, and pay scale.
Regardless of your opinion, please jump on with Greg Friese and I tonight on the EMS Educast, a LIVE and long-running popular podcast. The show starts at 9pm Eastern, which so I don’t forget is 8pm Central and 6pm PDT. The show is live and I would love to have anyone join us in the chat room and even call in.
Here’s the link: http://www.emseducast.com/live
Here’s the link to the article again: Saved By the Bell? High School Student EMS
The show starts at 9pm Eastern – Join us in the Chat Room and Call In to speak with Greg or myself.
Love my stance or hate it, it’s sure to be a great show.
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Also, if you’re reading this after the show, the EMS Educast and all previous episodes can always be found at www.EMSEducast.com
Look at the pictures below and see if you can identify the three occupations represented by the people in the pictures.
What are their jobs?
What are their areas of expertise?
What would you expect them to be responsible for?
Yep, pretty much everyone reading this and almost every lay person you can think of should probably be able to answer the above questions. The Police Car Driver chases bad guys; The Fire Truck Driver squirts water at things; and the Paramedic takes care of people who are sick and hurt, right? Sure, their jobs sometimes overlap and so does some of their training, but the jobs and the requisite education and responsibilities are different and separate for a reason. The different roles up there are different, specialized, and require expertise in order to be effectively performed… right?
And before you think that I’m opening the Fire Based EMS can of worms, I want to direct you to this news story I just read on EMS1.com – Kentucky EMTs not called for 5 hours until coroner ruled woman was alive. Go read this and then come back please. It got me all riled up and I’m sure it will you as well.
The moral of the story, is that police officers were called for a dead body found in some bushes some where. They started doing their cop stuff and didn’t call EMS to evaluate the body because their cop training told them that the woman was obviously dead. Unfortunately for all involved, when the coroner arrived he told them that their police-issued medical training wasn’t adequate and that the woman was indeed alive.
And yes, I am 100% sure that nobody intended for that to be the tragic result.. people make mistakes, I know… but:
How many times have you been called out in your ambulance to a potential medical emergency and then cancelled while en route? Have you ever wondered who is cancelling you and for what reason? When we arrive on scene, we evaluate the patient and determine their need for transport. We have extensive training to help us do this and we function within a complex set of laws and regulations to help ensure that bad outcomes like this happen as infrequently as possible. Unfortunately, however, things like this do happen, even to experienced paramedics. How many times have you heard news stories about paramedics calling someone dead only to have them be found alive later on? How many times have you heard about occult neck fractures and other severe injuries being found later even after a patient was evaluated by a physician? It happens, folks… and it happens to us medical people too. Even with the training, knowledge, skills, and experience we have that is specifically geared to emergency medical care that is again enhanced by the fancy tools that we carry with us, we sometimes still make mistakes…
So why in the heck would a police officer, who as stated above chases bad guys and does other kinds of “cop stuff”, want to make the decision that someone was dead or not? It simply doesn’t make any sense to me. I have always been leery of having police officers call us off of medical scenes. Even when I know the officer and trust his or her judgment, I know that my medical training and tools are superior to theirs. That’s the way the system is designed, we do medical stuff and they do cop stuff.
I think that there’s a pervasive trend out there that causes dispatchers to send police units first to things like auto accidents and possible crimes in progress and then potentially forget to send EMS. Most of the time, it’s perfectly ok and turns out just fine. Other times, incidents like the above happen. How many times, also, has a police officer determined an auto accident to not require medical response and an occult injury been found later? I don’t know and haven’t seen any statistics… but I’ll bet it happens a lot more than is ever reported.
My advice? I promise to let the cops to their cop stuff. They just need to always remember to call me out to do my stuff. I don’t mind doing the report if I’m not needed or I get a refusal, I just don’t want anyone to suffer needlessly.
Be careful out there.
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Want more of my thoughts on Fire Based EMS? See: “Fiddling While Rome Burns… The ambulance “industry”
Rural EMS has it’s challenges, not the least of which are the low pay and long hours. I believe that the lives of those in the sticks are just as important as the lives of those in the city and that rural folk need paramedics too. This is a fictional letter with a very real message. It could be written by a lot of paramedics and EMTs to a lot of people who live out in the sticks and I could have written this letter once when I left my small town EMS service to seek my EMS fame and fortune out there in the Big City. Now that I’ve come full circle and I’m once again working rural EMS I’m starting to wonder when I might have to write this letter again.
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Mr. and Mrs. Penry
1212 Gravel Road
SmallTown, USA.
Dear Mr. and Mrs. Penry,
My name is Chris and I am a paramedic working for your local EMS service. I live here on Mulberry St. in SmallTown and my parents and grandparents live out here as well. I’ve seen you on the street, at the local café, and pretty much anywhere in town for most of my life. I went to high school with your son, Johnny and thought about dating your daughter once but could never work up the courage to ask her out. I wanted to take her to the prom but I ended up taking Mary Buckrop instead. We sure got us in some trouble with the Sheriff when he caught us out by the lake, but he ended up letting us go. Thank goodness that he turned out to be so nice. He was one of the people that helped me through Paramedic school. He kept telling me that we needed good people for the ambulance out here in SmallTown and I’ve found out that he was right. We do.
That’s why I’m having trouble writing this letter to you, Mr. and Mrs. Penry. I’ve taken it upon myself to write a personalized letter to everyone in the SmallTown EMS district because I’m facing a hard decision that I’d like you all to know about. I’ve been a paramedic now for the last ten years. I became an EMT and started volunteering with the SmallTown EMS District right out of high school and did that while I worked down at the Grain Elevator and put myself through college over in MidSizeTown. It was there that I decided that I wanted to be a paramedic and I completed my paramedic training at St. MidSize Hospital. I immediately fell in love with the work and I knew that it was something that I always wanted to be a part of. I continued volunteering with SmallTown EMS while I worked a full-time job for MidSizeTown Ambulance Service. I worked there for seven years and got a good bit of experience. I also worked part-time at St. MidSize’s Emergency Room. I still do.
Three years ago when the voters approved SmallTown EMS District’s referendum to hire full-time paramedics, I jumped at the chance to come on board. This is my home. As cheesy as it may sound, I feel a connection with the people here in SmallTown and I feel that it’s my duty and my calling to protect them with my Paramedic skills. I’ve always studied and trained hard throughout my career to be the best paramedic I could be because I’ve felt it was my duty to be my best. I felt very good about coming on board with SmallTown EMS to protect my Neighbors, family, and Friends here in my hometown.
Rural EMS is different than is EMS in the city. Sure, we may not be as busy out here in SmallTown as we could be if we were a bigger city, but that doesn’t make it easier on us. People out here don’t have access to primary care since Doc. Walters closed up his shop. While they can drive out to see the clinic in MidSizeTown, that’s thirty miles away. Most people don’t make the drive as often as they should and since people aren’t getting regular checkups and primary medical care they tend to let their minor and chronic conditions get so bad that when they finally call us, it’s because they don’t have anything else they can do. A lot of the time, their minor condition has become life threatening because it got out of hand. We can take them to St. MidSize ER, but they don’t have the capability to do things like perform cardiac catheterization surgeries to fix heart attacks, or to take care of trauma patients that need surgery right away, or to handle complicated patients in their inpatient wards. Their “ICU” is staffed by some dedicated people, but it only has two beds. This means that we have to bypass St. MidSize ER for the bigger hospitals in BigTown and that’s an hour away for us running Lights and Sirens. Because we have such long transport times and because our patients tend to be pretty sick when they call for us, we have to provide critical care level interventions. We carry more medications with us than do the big city ambulances and we can do more things than they can. That’s because ambulances in the city don’t have to be with their patients for as long as we do. They have a hospital within ten to fifteen minutes transport time of anywhere they may be. We have one within thirty minutes to an hour away. The fact that we’re so far away from hospital care forces us to be on our game all the time. We also have to be on call a lot to cover the duty ambulance when it’s away transporting a patient to the Big City. A normal call can take two hours. A critical call can take three or four. If we didn’t listen up, the calls that happen while the duty ambulance is away wouldn’t get a paramedic. I try not to let that happen.
Here’s the deal, Mr. and Mrs. Penry, I’m not complaining about my job. I love it. I love the work and I really don’t mind all of the hours that I have to put in. While it’s hard on my family to have me gone so often, they have always understood. My wife Mary supports me in my desire to cover the town we grew up in. She has since Prom night. She’s been great. However, we’ve got our new little boy that just turned three this last month and he doesn’t understand why Daddy has to be gone so often. He also is starting to get very expensive, as kids do, and the meager salary I get working in town isn’t covering all of my bills. I took a pretty hard pay cut to come here. I wanted to and thought that I could keep my part-time job at St. MidSize to make ends meet. Unfortunately, since I’m always on call for SmallTown, I can’t hardly work any hours at St. Midsize. We don’t get paid to be on call, only for when we’re on duty and I’d say no to covering… but then someone in town might die because I’m not here to take the second call. I answer the second call all the time, like I did the night of Johnny’s car accident. I’ve heard he’s doing better but I can tell you that he probably wouldn’t be had I not decided to stay home and cover that night. Mary had plans to go to dinner in MidSizeTown but I just wanted to stick around for an hour to make sure the duty truck was back in town. I’m sure glad I did.
I’m going to come right out and say it. There’s a job opening in BigCity EMS that would pay me twenty-thousand dollars a year more than I make here in SmallTown. I’d be able to work one job and wouldn’t have to put in so many hours away from my family. We wouldn’t have to skimp and save to pay the bills nearly as hard as we do now. I’d love to stay here and take care of my home town but the pay is just too low to survive on. A lot of good people have left since we went full time when they realized they couldn’t survive on the pay. I’ve been doing my best to train the kids that they hired to replace them, but they only seem to be coming here to use it as a stepping stone to a better job in the big city. I think that our town deserves better but I can see why the people would leave. I didn’t become a paramedic to get rich but I don’t think that I deserve to live in poverty because I choose to help my home town. People out here need experienced paramedics just as much as the people do in the big city. The lives of the people in the city aren’t any more important than the lives of the people out here. I feel strongly about rural EMS and I feel strongly about my home town… I just can’t make it anymore. The bank might come take the house and my family doesn’t deserve to suffer because I choose to help those that can’t pay me back.
So, Mr. and Mrs. Penry, I’m asking you what you think I should do. One day the unthinkable is going to happen to someone and I want to make sure that there are good people to take care of them when it does, but I can’t have my family suffer financially anymore. My kid needs his daddy and my wife needs her husband. The bank needs the mortgage and my student loans need paying off. It’s a tough decision I’m facing and I’m asking the community what they think I should do.
If you need me, just call 911. I’ll come like I always do. If I’m not on the duty truck you can just stop by the house. You know how to get ahold of me. Say Hi to Johnny for me.
Sincerely,
Chris NREMT-P
Every now and then (Ok, a lot) I read something and say “Man, I wish I’d written that”. This isn’t one of those. This is one of those things that far exceeds my writing prowess. This is an open Paramedic Class Commencement speech written by David J. Givot, a Paramedic and Attorney. It is an absolute must read.
And that’s an order.
While there’s a deeper meaning to this piece, it also made me LOL. I had my wife, who is graduating Paramedic school tomorrow, read it too. Well done, Mr. Givot.
http://thelegalguardian.blogspot.com/2010/06/open-commencement-address-for-every-new.html
Enjoy.
I wrote this post for publishing in my community’s local newspaper. You may wish to send it to yours as well. It’s a generic “EMS Needs Your Support” piece. It might work for any time of the year, but it’s customized for EMS week 2010.
————————————————–
“Anytime. Anywhere. We’ll Be There” National EMS Week 2010
National Emergency Medical Services Week or “EMS Week” 2010 is coming up this year on May 16th through May 22nd. It is a time to think about the people whom our communities rely on to help us when the unthinkable happens. Every day in our community and in communities like ours throughout the nation, emergencies happen to people just like you and I. These local emergencies may not get the press coverage that the big disasters happening thousands of miles away receive, but to our friends and neighbors these day-to-day emergencies can be just as dangerous and deadly. We rely upon Emergency Medical Technicians (EMTs) and Paramedics to respond and make a difference in our lives. No matter the need, no matter the call, EMS stands ready to serve you.
Logo for EMS Week 2010 - from ACEP
EMS is at once the most iconic and visible part of the emergency healthcare system. It is also probably the most misunderstood. Almost everyone can recognize an ambulance and most people have an idea of its purpose. However people rarely give thought to the capabilities and education of the people working inside of it. EMTs and Paramedics have long since evolved from their humble beginnings as simply a fast ride to the hospital. Today’s ambulances are highly specialized mobile intensive care units and today’s EMT attends hundreds of hours of classroom education for their initial certification. Paramedics, the highest level of field medical providers, attend thousands of hours of initial education and internship time and must be masters of acute care. Not only that, but EMTs and Paramedics alike must recertify their license every few years and must attend hundreds more hours of continuing education to achieve their recertification. This training covers all aspects of acute emergency care and is quite intense and rigorous.
Today’s EMS system, with Paramedics and EMTs working in tandem, brings the first hour of Emergency Room care to the patient’s side no matter where the patient may be. EMS focuses upon providing immediate stabilizing care that stops or slows the progression of the acute disease process or damage from any injury, protects the patient from further aggravation of the condition, and impacts their long-term continuity of care. This care reduces Mortality, or loss of life, as well as Morbidity, or future quality of life. Calling 911 during a medical emergency produces better outcomes than does simply driving a seriously ill or injured person to a hospital. Early intervention in cases such as a heart attack or stroke can mean the difference between those conditions leading to long-term disability or a full recovery.
Every community in our region has emergency ambulance services available at a moment’s notice that are simply a 911 call away. Some communities provide Basic Life Support ambulances, with EMT level personnel. These ambulances are supported by Advanced Life Support ambulances and units staffed by Paramedics that can respond with the Basic ambulances to provide advanced level Paramedic care. It is important for people within our community to ask questions and get to know the people responding to their calls for help. Learn about their capabilities and their needs. Pitch in and help where you can. EMS people have always been the absolute masters of doing anything with nothing but we are desperately in need of the support and attention of the communities we serve. It is common for community members to not think about their local ambulance services until the time that they need their services however, EMS needs your support. Americans have always been massively charitable towards disasters happening thousands of miles away when images from them flood our television screens and newspapers, but rarely does that same charity flow to their local emergency responders who are taking care of our friends and neighbors. Your local EMS service needs your support to maintain high-levels of lifesaving service in your own communities. You can directly impact the service that your local EMS can give to your friends, your neighbors, your loved-ones, and even yourself.
Get informed, get involved, pitch in, and help us help you.
The official theme for EMS week 2010 is “Anytime. Anywhere. We’ll Be There.” EMS has made the commitment to be there for you. This week, please think about how you can be there for EMS. The impact of your support for EMS translates directly back into improving the lives of the people in our communities. As the saying goes, the life you save may be your own.
Respectfully,
Chris Kaiser NREMT-P
Chronicles of EMS/FireStorm Flyer
So, what are you doing this next Friday night? You know, Friday the 23rd of April… Are you going to be in Indianapolis? I’m going to be hanging out with some of my blogger buddies down at FDIC this year and I wanted to know if you w
ere interested in coming to hang out with us.
The Happy Medic‘s going to be there, @GinaKaiser’s going to be there too. I’ll be hanging out with them and some other really cool guys and gals at the Rock Bottom Restaurant and Brewery around 8pm (ish), which is just a block or two away from the Convention Center in downtown Indianapolis. The address of the place is 10 West Washington St. I’ve been there before with a buddy of mine the last time I was in Indy on business and it’s a good time (Ask about the Snake. It’s a cute story, actually).
So, you can just show up if you wanna. Or you could “@” me on Twitter (It’s @ckemtp if you didn’t know) and get directions. We’ll be kicking back, shooting the breeze, and talking about the stuff we’re talking about online and elsewhere. That, and fishing, and whatnot. It’s a guaranteed good time. If you’re there (and you really should get yourself there, because it’s going to be a hoot) definitely come up and say “Howdy!” I’d love to meet you.
Be there or be abberantly conducted.
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